동시성 대장암에 의한 이중 장폐쇄의 단계적 자가팽창형 금속스텐트 삽입 치료 1예
A Case of Inserting Two Self-expandable Metal Stents in Dual Malignant Colonic Obstructions
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장폐쇄를 동반한 대장암에서 응급 수술은 불량한 장정결 및 전신 상태로 합병증 발생 가능성이 높으며, 경우에 따라서는 회장루 형성이 불가피하다. 자가팽창형 금속스텐트 삽입은 이러한 환자에서 응급 수술을 피하고 계획된 수술을 가능하게 하며, 또한 근치 수술을 시행하지 못하는 환자에서도 증상 완화 목적으로 사용된다. 저자들은 두 부위에 장폐쇄를 유발한 동시성 대장암 환자에서 두 단계에 걸친 자가팽창형 금속스텐트 삽입술로 성공적으로 장폐쇄를 치료하여 보고한다. 66세 남자가 복부팽만감으로 내원하여 장폐쇄를 동반한, 하행결장 원위부 및 비장만곡부의 동시성 대장암을 진단받았다. 급성 장폐쇄를 해결하기 위해 대장내시경을 통해 하행결장 원위부에 자가팽창형 금속스텐트를 삽입하였으나 증상 호전 없어, 비장만곡부에 스텐트를 추가 삽입하였고, 이후 성공적으로 감압이 유도되었다. 동시성 대장암에 의한 이중 장폐쇄의 경우에도 자가팽창형 금속스텐트 삽입술은 매우 유용할 것으로 생각한다.
Abstract
Malignant colonic obstruction can lead an emergency operation for decompression, and this can cause post-operative complications due to poor bowel preparation. Self-expandable metal stent (SEMS) insertion is useful for avoiding an emergency operation and unnecessary complications. However, SEMS insertion for dual malignant colonic obstructions is very rare. We report here on a case of two SEMS that were inserted in dual malignant colonic obstructions caused by synchronous colon cancer. A 66-year-old man visited our hospital due to abdominal distension. Sigmoidoscopy and an abdominopelvic computerized tomographic (CT) scan revealed synchronous colon cancer at the splenic flexure and distal descending colon with dual obstruction. The initial SEMS insertion on the descending colon was not effective for decompression due to the proximal obstruction. After the second SEMS insertion on the splenic flexure through the first stent, all the signs and symptoms due to obstruction disappeared. SEMS insertion is considered to be useful for treating dual malignant colonic obstruction caused synchronous colon cancer.
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